This is the podcast, ICU rounds.

My name is Dr. Jeffrey Guy.

I'm an associate professor of surgery and director of the Burns Center at the Vanderbilt University School of Medicine in Nashville, Tennessee.

We'll check up on our discussion of pancreatitis. our last podcast part one of this two-part series

we talked about how do we make the diagnosis of pancreatitis what are some of the clinical

findings what is the etiology and how would we image a patient with pancreatitis in this podcast

I like to focus more on some of the management issues of what we do in the

intensive care unit.

When should a patient go to the operating room?

When should they get antibiotics?

And when they go to the operating room, what should be the operation?

Now, if you diagnose your patient with severe acute necrotizing pancreatitis, that's a patient

who clearly needs to be in the

intensive cure unit. Now, patients need to be monitored frequently for signs of end-organ

dysfunction. They can be profoundly hypovalimic. They can have renal insufficiency, develop shock,

and hypoxemia. This progression of the disease or the deterioration of the patient can

typically occur within the first 48 hours.

Now, Seres, which we've previously defined as a systemic inflammatory response syndrome, may occur sometimes over the first week.

So a patient will get rapidly, very ill, and then basically within five to seven days be in multi-organ dysfunction.

The resuscitation of the patient is really the cornerstone of the therapy,

and fluid sequestration into the third spaces can be massive,

with about one-third of the plasma volume being sequestered.

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